Thursday, September 10, 2009

Either/Or - Healthcare edition

Matthew Yglesias writes:
The private system is slowly but surely failing, and only public programs are preventing lack of health insurance from spiraling out of control.
And provides corresponding numbers of decreasing private insurance rolls and increasing public ones.

While there's nothing wrong with his numbers, his conclusion appears suspect to me.

Why isn't declining private insurance enrollment proof that the current "private insurance system is slowly but surely failing"? Why are public programs the only viable alternative to the current system? I suspect that in this case, Yglesias' preferred alternative is being presented as the "only" alternative.

I am still waiting for someone to come up with a plan that represents a real break with the current system and the current proposed solution. I believe a plan that represents such a break would include the following:
  • An acknowledgment that the current system doesn't work for many people and the fact that it is employer based is an impediment to labor mobility.
  • Willingness to concede that $3 or $4 thousand of health care expenses in a year doesn't mean that the government needs to employ an army of doctors or insurance agents just to make sure you are insulated from the cost of maintaining your own health. If it's valuable, why should it be free?
  • A refusal to call health care a right, but a recognition that one of the richest and greatest nations on earth has a moral obligation to help care for those citizens that need help.
  • Acceptance of the idea that getting sick should not mean financial ruin.
  • A realization that a health care safety net should kick in when you need an organ transplant or have a chronic illness that requires lots of expensive treatment not when your ear hearts and you want someone at the emergency room to shine a light in it at 3am and give you some pills.
  • A belief that the government, in its unique position, can play a temporary role in transitioning us from the current system to a different, better, but still private system.
  • Understanding that once the government is involved, there is no assurance that it will leave, but the introduction of a government-run public option will guarantee that government will never leave. And that this represents a level of government intervention in the private sphere that is ultimately incompatible with a free society.
None of these notions seems particularly radical to me and seem to have portions that would appeal to those on both sides of the current debate. Given that, why is such a synthesis completely missing from the discussion?


Anonymous said...

i didn't even attempt to read this because 1. it's late and 2. i wouldn't understand it even if it was the afternoon. i just wanted to creep on you so you could find out what my internet server said and get you excited that you got a comment and then surprise! it's just me! hahahahh

Steve said...

Excellent synopsis of a working plan's points. The only phrase that causes lunatics to lose their heads and become completely irrational is the phrase "free society". Why, I do not know.